What are the indications for surgical intervention in patients diagnosed with cholesteatoma?

Surgical intervention is the primary and only curative treatment for cholesteatoma ¹. The extent of the cholesteatoma lesion determines the specific type of surgery required ¹. For instance, mastoidectomy may be necessary if there is extensive disease ¹.

Urgent surgical intervention is indicated in patients presenting with suspected cholesteatoma who also exhibit signs of serious or life-threatening complications ¹. These include an associated facial nerve palsy, neurological symptoms or signs, or if the patient is systemically unwell, as these may suggest more extensive or advanced disease ¹. Clinical features indicative of complications such as acute mastoiditis, intracranial abscess, or meningitis also necessitate urgent hospital admission or specialist ENT advice, often leading to surgical management ¹. Delayed treatment in cases with facial nerve palsy is associated with a poor prognosis ¹.

For all patients diagnosed with cholesteatoma, prompt referral to an Ear, Nose, and Throat (ENT) specialist is arranged for further assessment, confirmation of the diagnosis, and consideration of surgical intervention ¹. High-resolution CT imaging of the temporal bone is often used to define the extent of the cholesteatoma, identify bony erosion, and assess for other complications, which guides surgical planning ¹. Endoscopic management is also a recognized surgical approach for primary acquired cholesteatoma (Chiao et al., 2021).